Provider Demographics
NPI:1801583307
Name:MILBURN, LINDA A (LCSW, LCDC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:MILBURN
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 N FM 157
Mailing Address - Street 2:
Mailing Address - City:VENUS
Mailing Address - State:TX
Mailing Address - Zip Code:76084-3248
Mailing Address - Country:US
Mailing Address - Phone:817-905-3909
Mailing Address - Fax:
Practice Address - Street 1:5020 N FM 157
Practice Address - Street 2:
Practice Address - City:VENUS
Practice Address - State:TX
Practice Address - Zip Code:76084-3248
Practice Address - Country:US
Practice Address - Phone:817-905-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX624311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical